Reducing Aerosolized Particles and Droplet Spread in Endoscopic Sinus Surgery duringCOVID-19

Objectives The presence of high SARS-Cov-2 viral loads in the upper airway, including the potential for aerosolized transmission of viral particles, has generated significant concern amongst otolaryngologists worldwide, particularly those performing endoscopic sinus surgery (ESS). We evaluated a simple negative-pressure mask technique to reduce viral exposure. Methods Two models simulating respiratory droplets >5-10 mu m and fine respiratory nuclei <5 mu m using fluorescein dye and wood smoke, respectively, were utilized in a fixed cadaveric study in a controlled environment. Using ultraviolet light, fluorescein droplet spread was assessed during simulated ESS with powered microdebrider and powered drilling. Wood smoke ejection was used to evaluate fine particulate escape from a negative-pressure mask using digital subtraction image processing. Results The use of a negative-pressure mask technique resulted in 98% reduction in the fine particulate aerosol simulation and eliminated larger respiratory droplet spread during simulated ESS, including during external drill activation. Conclusions As global ear, nose & throat (ENT) services resume routine elective operating, we demonstrate the potential use of a simple negative-pressure mask technique to reduce the risk of viral exposure for the operator and theatre staff during ESS. Level of Evidence 5Laryngoscope, 2020

Automated summary

The study evaluated a technique using negative-pressure mask to reduce viral exposure in the upper airway, demonstrating a 98% reduction in fine particulate aerosol simulation during simulated surgery.